Eye contact is an important component of human-to-human communication, being used often by both children and adults to communicate with most others in their daily lives. Children who habitually fail to make eye contact often face challenges and difficulties in life that most people do not, and failing to make eye contact is a common sign of autism. In fact, according to AutismTreatmentCenter.org, eye contact (alongside speech) is one of the main development challenges faced by children with autism, and as such, it is not surprising that the topic has been addressed many times by numerous researchers. Here I quote a passage from a 2013 paper by Carbone et al in reference to prior research in the field in which the authors cite several other works:                “It has been suggested that eye contact, sometimes referred to as (eye) gaze behavior or eye-to-face gaze (Mirenda, Donnellan, & Yoder, 1983) serves an important social function for young children even before vocal responding begins to develop (Stern, 1985). In early development, eye contact serves to regulate face-to-face social interactions (Lee, Eskritt, Symons, & Muir, 1998; Leekam, Baron-Cohen, Perrett, Milders, & Brown, 1997) and contribute communicatively to social interactions (Tiegerman & Primavera, 1984). Later, eye contact responses coordinate the visual attention between another individual and an object of interest (Arnold, Semple, Beale, & Fletcher-Flinn, 2000) and have been found to be an influencing variable in language acquisition (Podrouzek & Furrow, 1988).        “Deficits in various nonverbal social-communicative behaviors, particularly in dyadic (i.e., eye-to-face) and triadic eye gaze (i.e., joint attention directed at a third party or object) are commonly identified as the earliest indicators and most noticeable deficits of developmental delays and of Autism Spectrum Disorder in particular (Baron-Cohen, Allen, & Gillberg, 1992; Mirenda et al., 1983; Wimpory, Hobson, Williams, & Nash, 2000; Woods & Wetherby, 2003). Because of the various social functions eye contact may serve, failure to emit this important behavior may have significant implications for children with autism. In addition, there are possible educational concerns associated with poor eye contact. Specifically, previous research has suggested that the diversity of prelinguistic pragmatic skills exhibited (e.g., eye contact, joint attention) is predictive of the rate of subsequent vocabulary acquisition (Kleinke, 1986) and it has also been suggested that poor eye contact may adversely affect the educational gains of children with autism due to the relationship between eye contact and attending to the teacher and instructional demands (Greer & Ross, 2007; Lovaas, 1977).” (Carbone et al, 2013)        
Autism spectrum disorders, including autism itself, are characterized by “(a) impaired social interactions and failure to develop social relationships, (b) impaired and disordered language and communication, and/or (c) occurrence of restricted and repetitive behaviors.” Boys are affected 3 to 4 times more often than girls. The cause of ASD is considered unknown in 90 to 95 percent of cases (Boyd et al, 2010).
Ultimately, “there is no aetiology-based intervention for [ASD]” (Francis, 2005) and consistent with this, credible therapies tend to address the symptoms of the condition—behaviors—rather than any biological causes. Similarly, pharmacological treatments are available for “hyperactivity, impulsivity, inattention, aggression, irritability, anxiety, and withdrawal,” but do not address any root cause of the condition. (Tchaconasa and Adesman, 2013) Special diets—casein-free, gluten-free, etc.—aimed at the problem, typically have no scientific basis. Early intervention—starting when the child is as young as possible—is generally considered important in obtaining a good prognosis.
There are numerous strategies that are used by psychiatrists, therapists, parents, teachers, professionals, and other caregivers in the treatment of autism. For the purposes of this discussion of prior art, I will with great generality classify these strategies as being largely of three types. First, there are those based heavily on the principles of Applied Behavior Analysis (ABA), principles that although they have been upheld by the medical community for decades, and have considerable research demonstrating their effectiveness statistically, are not without criticism. Second, there are many alternative therapies that often come to be favored by parents due to a somewhat softer approach to the condition. Some of these are without any scientific basis, and others simply lack hard supporting data, though more recently, some aspects of these child-directed and natural environment therapies have found better support from research. Third, there are strategies that combine aspects of each of the first two types, and such hybrid strategies are of growing popularity. After a brief overview of these strategies, I will indicate some of the ways that technology is being incorporated.
The most established treatments for autism and ASD in children—including and especially that targeting the important symptom/cause of problem eye-gaze behavior—typically involve aggressive therapy programs based on the psychological principles of Applied Behavior Analysis (ABA). ABA has been successfully used in the treatment of autism since the 1960s (Tchaconasa and Adesman, 2013), and uses positive and negative reinforcement in order to increase or decrease the prevalence of certain behaviors. It is often effected as Discrete Trial Training (DTT) whereby a simple antecedent stimulus is presented to the child, and the child's response to this stimulus can immediately be reinforced appropriately. In the context of treating eye-gaze behavior specifically, this extrinsic motivation might proceed with a caregiver providing an antecedent prompt to the child “look at me,” and given a satisfactory response, the child would be given an edible reward (Brown and Bradley, 2014). Over time, after a number of discrete trials have begun to show progress towards the extinction of problem eye-gaze behavior, the use of edible rewards can be faded out. In this manner, ABA seeks to induce affected children to act in ways that in the future they will learn the benefits of.
ABA has gained great respect amongst practitioners due to peer-reviewed supporting research, including the work of Ivar Levaas, who in the late 1980s, began to produce some of most compelling empirical evidence demonstrating the effectiveness of ABA-DTT techniques in treating autism. Since then, many others have found the same, and today, ABA techniques are unique amongst treatment tactics in that they have found widespread acceptance and endorsement. For the purposes of treating autism, ABA has been formerly endorsed by many medical organizations including the American Academy of Neurology, the American Academy of Family Pediatrics, the American Academy of Pediatrics, the American Psychological Association, the American Speech-Language Hearing Association, the Society for Developmental and Behavioral Pediatrics, the Autism Society of America, the National Institute of Child Health & Human Development, and the National Institute of Mental Health; it is routinely touted by Autism Speaks, the largest autism-related nonprofit in the United States; and in 1999, it was endorsed by then United States Surgeon General Dr. David Satcher (appliedbehaviorcenter.com).
However, despite this obvious and thorough acceptance of ABA, some aspects of it have been criticized, including DTT in particular. Ultimately, ABA is something of a “carrot-and-stick” approach, and some critics have noted the potential superiority of intrinsic motivation. Some parents have expressed worry and/or dissatisfaction regarding the results as well, claiming that ABA can/could make their child act in ways that might be considered “robotic”, exhibiting more desirable behaviors only because they were induced, and not as manifestations of the child's personality (iancommunity.org indicates Steege et al, 2007). In addition, while ABA techniques have never drawn the same level of ire as did the Behavior Modification techniques of the first half of the twentieth century, some formerly autistic children who have grown to become high-functioning adults have criticized aspects of ABA as unethical (Dawson, 2004). Part of this criticism is certainly due to the use of aversive consequences to discourage unwanted behaviors, techniques that-out of favor today-were notably used during Ivar Lovaas's seminal work on the subject. The following passage from a 1977 paper documents such an aversive technique:                “ . . . the therapist said ‘[the child's name], you didn't look at me,’ in a stern voice and then began functional movement training . . . where the child was required to move his head in one of three directions-up, down, or straight and a verbal instruction was given for each position (e.g., ‘head up’). The child had 1 sec in which to respond to the instruction, after which the therapist began guiding his head manually in the desired direction. The therapist stood behind the child, who remained seated throughout the functional movement training period. If the child began the desired movement at any time during the guidance, the guidance was eliminated and the therapist merely shadowed the child's head with her hands. However, she reapplied the guidance whenever the desired movement ceased. The child was required to sustain each posture for 15 sec. The order of the instructions was random so that the child would attend to the verbal instruction, rather than learning a particular sequence. Approximately 20 sec after the functional movement training period had ended, a new eye-contact trial was begun.” (Foxx, 1977)        
Ultimately, some researchers continue to note that in severe cases the use of aversive consequences may yield superior results than the use of positive reinforcement alone (Foxx, 2005). However, the diagnostic criteria for autism/ASD are, today, broader than they used to be, and the recent explosion in autism and ASD cases has resulted in many children being diagnosed with ASD who in previous generations would have had their conditions remain unrecognized (Gernsbacher, Dawson, and Goldsmith, 2005). For these less severe cases—perhaps the bulk of the cases today—strict implementations of ABA complete with aversives may be less appropriate.
The archetypal alternative to the strict application of ABA-DTT, might be called child-driven/directed or naturalistic. If ABA-DTT concerns a series of short iterations, each initiated by the therapist, each with a defined and measurable outcome, then a child-directed or naturalistic scheme focused around play is the opposite. Such a strategy is less rigidly defined and seeks to follow the child according to his/her interests, legitimizing those interests, and hopefully allowing for a bond to form between caregiver and subject. In the context of eye-contact, one may note the following suggestions as provided to a parent by the director of a therapy center that promotes a child-directed program:                “Position yourself at or below his eye level consistently. It's less eye strain and easier [for him] to look at you this way. When you give him an object, hold it to your eyes, so that he must reach out and grab it. You are right there, behind the object! Whenever [he] does look at you, celebrate him for it! Tell him how much you appreciate him looking. He may not know how special it is to you.”—Bryn Hogan, Director, the Son-Rise Program (AutismTreatmentCenter.org)        
In contrast to ABA, in which the therapist virtually—or even literally—might instruct/order/induce a child to notice, do, or say something, it seems that practitioners of a child-directed strategy prefer to actively compete for the child's attention. This is clearly a softer, gentler, more friendly approach.
Research regarding child-directed strategies is mixed, due perhaps to the significant variation between strategies. While a few child-directed programs aimed at parents tout miraculous results, often the research supporting such programs is simply anecdotal, with strict control groups typically absent, which leaves such programs unendorsed relative to ABA.
On the other hand, some credible research, as mentioned above, backs the use of some of the characteristic alternative techniques of child-directed/naturalistic strategies. For example, imitating an affected child's behavior-what might be considered a child-directed technique by definition—was shown as early as 1984, to, in some instances, result in greater eye contact (Tiegerman and Primavera, 1984). Other studies have also found similar results: for example, one observed that children responded favorably to a protocol that included contingent imitation on the part of the practitioner, and that in response, the child subjects demonstrated increased “use of eye gaze and [reciprocated] imitation [on the part of the child] of familiar actions that generalized to novel con-texts” (Hwang and Hughes, 2000, as cited by Ingersoll, 2008). Ultimately, these and other positive findings have likely influenced specific aspects of some treatment programs directly. Such would certainly seem to be the case for one strategy known as Reciprocal Imitation Training (RIT)—a strategy that notably contains ABA aspects, but also the very natural, child-driven technique of imitation. A general outline of the teaching components for RIT indicates specifically that in order for a caregiver to increase the level of eye contact on the part of a child that the caregiver might “imitate[s] the child's actions with toys, gestures/body movements, and vocalizations at the same time as the child.” (Ingersoll, 2008)
Most recently, the trend has been toward programs that include aspects of ABA while also focusing more on the relationship between caregiver and subject, and expectedly, such finds more common support between professionals and parents who are both active in the treatment process. Examples include the Children's Toddler School, Project DATA for Toddlers, the Early Start Denver Model, the Early Social Interaction Project, and the Walden Toddler Program (Boyd et al, 2010). One resource notes that “sensory social routines such as peek-a-boo and ‘I'm gonna get you,’ provide opportunities for eye contact, child initiations to continue the activity, reciprocity, anticipation, joint attention and sensory regulation” (JustKidsSchool.com). Some have applied the moniker Natural Environment Teaching (NET), yet indicated treatment techniques such as the following:                “A learner and a therapist are playing together, with the therapist tickling the learner (and tickling is preferred by the learner). The therapist then pauses tickling and looks expectantly at the learner with an anticipatory expression and hands raised in the air. After several seconds, the learner looks in the direction of the therapist, who immediately resumes the tickling activity, and praises the learner as soon as he makes eye contact.” (Granpeesheh et al, 2014)        
While the above seems far more natural than any procedure that might involve the use of edible rewards or functional movement training as described in Foxx's 1977 paper, the above suggested technique also clearly follows ABA's antecedent-response-consequence framework. Despite this, proponents of NET, at times, deride DTT: “while [DTT's] approach to increasing eye contact may have its benefits, it can often lead to individuals only making eye contact when instructed to do so or using patterns of eye contact that appear unnatural.” (Granpeesheh et al, 2014) Truly, such would seem less likely with NET.
Turning now to the topic of applied technology, numerous technology products have been found helpful in both therapy as well as the education of children with autism. For example, teenagers with autism have been found to derive significant benefits from the use of Personal Digital Assistants (Gentry et al, 2010). Certain types of software that has been found to make subjects more engaged and less resistant to the learning process (Williams et al, 2002) as well as more attentive, more motivated, and ultimately apt to greater achievement (Moore and Calvert, 2000). Technology in the realm of Augmentative and Alternative Communication, especially Picture Exchange Communication Systems, has been very successful in both improving speech and facilitating alternative ways to communicate (Preston and Carter, 2009). Tablet computers have been found to be particularly useful in this context.
Very few software applications seem to have addressed the problem of eye contact specifically. A collaboration between Samsung and Autism Speaks has yielded the Look At Me product, a smartphone app that seems to aim at encouraging individuals to focus on eye contact as they take photos of other people. In addition, Goatella's Eye Contact Trainer app as well as the tablet apps of the Look In My Eyes series from FizzBrain LLC have a very simple, common game format aimed at the problem. Autism Speaks indicates the research supporting the use of the Look In My Eyes series as being “anecdotal” (autismspeaks.org); however, there may be some rightful skepticism about whether time spent with such tablet apps would truly increase the amount of attention that would later be paid to caregivers and people in general.
A number of robotic toys intended to help kids affected with autism have also been developed, and these developments are closely associated with the new and growing field of Socially Assistive Robotics (SAR). A 2012 review (Scassellati, Admoni, and Matarić, 2012) documented research regarding roughly a dozen robots of varying complexity—most having at least some anthropomorphic features—that might be used in the context of autism therapy. Most of the examples came from academic groups affiliated with universities such as the University of Southern California, the University of Hertfordshire, the University of Sherbrooke, University of Pisa, and Miyagi University. Very few of the robots discussed in this 2012 review were commercially available—perhaps limited to only two: each of “Pleo,” a robotic dinosaur, and Sony's “Aibo,” a robotic dog—and neither of these were specifically intended for therapeutic use, being preferentially aimed at a broader toy market.                “The main intended role of a SAR system in autism therapy is to allow or encourage children to develop and employ social skills. To this end, robots can be designed to take part in numerous different interaction goals, such as capturing and maintaining attention, evoking joint attention, eliciting imitation, and mediating turn-taking.” (Scassellati, Admoni, and Matarić, 2012)        
Researchers typically give affected children the opportunity to interact with a robot in the presence of a therapist or in the presence of other children, usually over the course of several dedicated sessions during which the robot's ability to elicit effects can be assessed. The length of such sessions varies, depending most often on the attention span of the children (Cabibihan et al, 2013). Research has typically shown that—at least during the session—the robots have the distinct ability to improve socialization, not simply in relation to the robot, but in relation to other people who are present during the session.                “In many studies, children with ASD interacting with robots show spontaneous joint attention behavior—for example, looking at an adult and back to the robot or pointing to the robot and looking at an adult or another child, with the intention of sharing some feature with that person. Children with autism show this behavior de-spite previously displayed tendencies to avoid eye contact or engagement with unknown adults.” (Scassellati, Admoni, and Matarić, 2012)        
This response on the part of affected children seems to mirror the response that would be seen in any person/group who/that might be confronted with something extremely new and different-amazement, the seeking of a sort of confirmation that their eyes are not deceiving them, and perhaps a general revelry in the experience. (For example, consider a group of people all absorbed in their own activities, work or otherwise. If a UFO were to suddenly land near them, it would draw all of their attention away from those individual activities, and those people would all proceed to socialize over their own amazement in the arrival of the UFO.)
What is more, it has been implied that such robots have some distinct advantages even in relation to the capability of human caregivers to elicit certain responses, the robots exploiting a distinct tendency of affected children to show an affinity for and more easily interact with things that are somewhat less than human.                “Some of these behaviors observed during interactions involving children with autism and robots can be attributed to the fact that robots provide novel sensory stimuli, but some-such as turn-taking with another child, manifestations of empathy, or initiation of physical contact with the experimenter-suggest that robots occupy a special niche between inanimate toys (which do not elicit novel social behaviors) and animate social beings (which can be a source of confusion and distress to children with autism). The goal of researchers investigating SAR for autism treatment is to develop robots that elicit these positive and productive interactions.” (Scassellati, Admoni, and Matarić, 2012)        
Since the 2012 review, two commercially available examples have moved to the forefront. One is Aldebaran Robotics's “NAO”, a robot that was initially introduced in 2007 August for the purpose of teaching older—and for the most part, neurotypical—children about technology and robotics. Similar to Pleo and Sony's Aibo, units of NAO have—for general, not-necessarily autism-related use—been produced in the thousands, and since 2012, NAO has, given its widespread availability, been harnessed by numerous universities as an object for autism related studies. Research results seem to be mixed, with some reporting of increased joint attention and positive effects on eye gaze, and others of less impact on joint attention and eye gaze effects that only occur relative to the robot, not to humans present at the time or afterward (Tapus et al, 2012).
The second recent commercial robot of note—introduced in 2015—is that of RoboKind's “Milo” which, unlike other commercial examples, is specifically intended for autism treatment. Milo is related to a prior product, “Zeno”, that was intended for use in robotics research and was in development since at least the mid 2000s. Peer-reviewed research on the effectiveness of Milo is not yet available, though RoboKind's claims that the robot has positive effects on joint attention and eye gaze behavior is consistent with that of SAR research in general and the robot's anthropomorphic design.
To date, robots used in autism and ASD therapy—even when intended to improve a subject's eye-gaze behavior—have not typically utilized animatronic eyes that duplicate the phenomenon, although some are programmed to exhibit some matter of gaze direction in the course of interacting with subjects. Two such robots are KASPAR, a product of the University of Hertfordshire; and FACE, a product of the University of Pisa. KASPAR, a humanoid robot about the size of a small boy, designed by its creators as “minimally expressive,” has been the subject of SAR/autism-related research since the mid 2000s. Consistent with much SAR/autism-related research, KASPAR has been used as a “social mediator” (Scassellati, Admoni, and Matarić, 2012; Dautenhahn et al, 2009). More relevantly, KASPAR was involved in a series of studies in which the robot would play “peekaboo” with subjects, a game that notably centers around eye contact, though without requiring any great degree of eye movement (Dautenhahn et al, 2009). FACE is also a humanoid robot, or more accurately, simply the head of one, and like KASPAR is capable of displaying emotions, though perhaps to a greater degree. FACE was also initially developed in the mid 2000s, and continues to be the subject of laboratory research, some of which has been related to autism (www.faceteam.it).
Robots otherwise capable of making eye contact—outside the context of autism therapy—have been created in laboratories since at least the 1990s. Several examples have been created in a laboratory setting at the MIT Media Lab by Professor Cynthia Breazeal and the Personal Robots Group. these would include each of three robots named as “Lexi”, “Leonardo”, and “Kismet”. These robots often have been programmed to utilize their own robotic gaze in social interactions with people. As such, certain examples have been programmed to utilize eye gaze maneuvers to perform different functions in the context of conversation. For example, Kismet, when in the midst of a conversation where eye contact was obtained, was programmed to look to the side in order to “hold the floor” before speaking—presumably indicating to the interacting person that the robot was no longer attending to the person's speech/actions/communication, but was instead preparing to speak/communicate itself. Similarly, a gaze, by the robot, directed at a person interacting with it was intended to show that that person had the robot's attention (Breazeal, 2003).
One of the most relevant examples of robots intended to make eye contact is that of “Robotinho”, a robot developed at the University of Bonn and introduced as an experiment in the role of a tour guide for children at the Deutsches Museum. Robotinho is notable, not simply for having animatronic eyes that make eye contact with people in its surroundings, but for doing so at a speed and fluidity that allows for significant engagement. Robotinho “focuses its attention on the person who has the highest importance, which means that it keeps eye-contact with this person. While focusing on one person, from time to time, [Robotinho] also looks into the direction of other people to involve them into a conversation.” (Faber et al, 2009)
The invention described herein is an attempt to apply newly available technology to the problem of autism and ASD treatment. Some of what is described in this application would not have been possible five or ten years ago. Parts of it share some similarities with some of the aforementioned technologies, but this invention also brings a novel focus, design, and function as well. It is possible that it might be used in conjunction with some of the aforementioned treatment strategies, but it also is meant to act on its own, with an altogether different mode of action.